Healthcare Provider Details

I. General information

NPI: 1639441165
Provider Name (Legal Business Name): CENTRAL WASHINGTON SLEEP DIAGNOSTIC CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W INDIAN AVENUE
BREWSTER WA
98812
US

IV. Provider business mailing address

PO BOX 1092
BREWSTER WA
98812-1092
US

V. Phone/Fax

Practice location:
  • Phone: 509-689-0100
  • Fax: 509-689-0596
Mailing address:
  • Phone: 509-689-6666
  • Fax: 509-689-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC E HAEGER
Title or Position: OWNER
Credential: MD
Phone: 509-449-0619